Pharmacology Chapter 58
Which statement is the most important for a nurse to make to a patient who is taking methimazole? A) "You need to notify your doctor if you have a sore throat and fever." B) "Another medication can be given if you experience any nausea." C) "You may experience some muscle soreness with this medicine." D) "Headache and dizziness may occur but not very frequently."
Correct: A Agranulocytosis (the absence of granulocytes to fight infection) is the most serious toxicity associated with methimazole. Sore throat and fever may be the earliest signs. Nausea, muscle soreness, and headache and dizziness are other adverse effects of methimazole that are not as serious as agranulocytosis.
Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine (Synthroid)? A) Tachycardia B) Tremors C) Insomnia D) Irritability
Correct: A High doses of levothyroxine may cause thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. Tremors, insomnia, and irritability are other symptoms of thyrotoxicosis and should be assessed after tachycardia.
A patient has been given instructions about levothyroxine (Synthroid). Which statement by the patient indicates understanding of these instructions? A) "I'll take this medication in the morning so as not to interfere with sleep." B) "I'll plan to double my dose if I gain more than 1 pound per day." C) "It is best to take the medication with food so I don't have any nausea." D) "I'll be glad when I don't have to take this medication in a few months."
Correct: A Levothyroxine is used to treat hypothyroidism by increasing the basal metabolism and thus wakefulness. It is administered as a once-daily dose and is a lifelong therapy. It is best taken on an empty stomach to enhance absorption.
Which finding in a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) would require follow-up by a nurse? A) Cardiac dysrhythmias B) Excessive bruising C) Weight loss of 5 kg D) Shortness of breath
Correct: B Levothyroxine intensifies the effect of warfarin, an anticoagulant that increases the patient's risk for bleeding. The warfarin dose may need to be reduced. Bruising, weight loss, and shortness of breath are not effects associated with interactions of levothyroxine and warfarin.
A nurse is caring for a patient with decreased triiodothyronine (T3) and thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels. The nurse knows the patient is likely suffering from what? A) Thyrotoxicosis B) Hypothyroidism C) Hyperthyroidism D) Graves' disease
Correct: B The anterior pituitary increases production of TSH when thyroid hormone levels of T3 and T4, are reduced, reflecting primary hypothyroidism. Patients may experience fatigue caused by a lowered basal metabolic rate. Thyrotoxicosis, hyperthyroidism, and Graves' disease are medical conditions indicative of excessive thyroid activity.
A nurse should consider which diagnostic test a priority to obtain before a patient receives iodine-131 (Iodotope)? A) White blood cell (WBC) count B) Electrocardiogram (ECG) C) Beta human chorionic gonadotropin (hCG) test D) Creatinine level
Correct: C Any female patient of reproductive age requires a negative result on a beta hCG (pregnancy hormone) test before iodine-131 (131I) can be administered. 131I is a radioactive isotope used to treat hyperthyroidism and is contraindicated in pregnancy and lactation. A WBC count, ECG, and creatinine level are not indicated before treatment with iodine-131.
A patient with Graves' disease is treated with iodine-131 (Iodope) therapy. Which statement by the patient would indicate understanding of the treatment's effects? A) "I'll have to isolate myself from my family so I don't expose them to radiation." B) "I'm looking forward to feeling better immediately after this treatment." C) "I'll tell my doctor if I have fatigue, hair loss, or cold intolerance." D) "I'll need to take this drug on a daily basis for at least 1 year."
Correct: C Iodine-131 usually is given as a single treatment to produce remission of Graves' disease. Fatigue, hair loss, and cold intolerance are signs of hypothyroidism, which is a complication of the treatment. Iodine-131 has a quick radioactive decay and half-life; therefore, isolation is not needed, but it can take up to 2 months for the desired response to develop.